Healthcare Provider Details

I. General information

NPI: 1093219339
Provider Name (Legal Business Name): CHARLOTTE SMITH HAND MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHARLOTTE M SMITH MD

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 07/01/2022
Certification Date: 07/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1248 AUGUSTA WEST PKWY
AUGUSTA GA
30909-1854
US

IV. Provider business mailing address

1248 AUGUSTA WEST PKWY
AUGUSTA GA
30909-1854
US

V. Phone/Fax

Practice location:
  • Phone: 706-863-0500
  • Fax:
Mailing address:
  • Phone: 706-863-0500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number9942
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number91215
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: